Life Ruined After Nebido. What Now?

Pharma / TRT Testosterone Replacement
1

I have been searching for answers by going through a lot of threads for weeks now and finally decided that i have to create my own.

Hopefully you can tolerate my English as it’s not my native language.

Short information about me:
I am 36 years old , 76kgs (%17 body fat) 1.80cm. I am working out since June’18 (weightlifting and minimal to non-existent cardio) 4-5 days a week. Diet is clean other than occasional junk food. %45 Protein / %35 Carbs / %20 Fats. Job is often quite stressful to the point where i want to resign. The only reason i didn’t yet is because it’s family business and it’s a big company. And money too. I got a new born child to feed.

I was tired all the time and could not feel refreshed even after 10 hours of sleep. I did not have the best libido although i never had ED. (All these symptoms were the same before i started working out a year ago.) Lack of focus also… Typical low t symptoms , although i did not know that by then.

Below is my first blood test from 14th of March 2019 (this is before the Nebido injection) :

|Glucose| 87| mg/dL| 74 - 106| |
|(BUN)| ▲21.5| mg/dL| 7.94 - 20.09| |
|Creatinine| ▲1.27| mg/dL| 0.67 - 1.17| |
|Uric acid| 6.81| mg/dL| 3.5 - 7.2| |
|[Cholesterol)l| ▲249| mg/dL| 0 - 200| |
|Triglyceride | 90| mg/dL| 0 - 150| |
|HDL Cholesterol| 47| mg/dL| 30 - 60| |
|LDL Cholesterol| ▲184| mg/dL| 0 - 130| |
|Total Bilirubin| 0.69| mg/dL| 0.2 - 1.2| |
|Indirect Bilirubin| 0.59| mg/dL| 0.1 - 1.0| |
|Direct Bilirubin| 0.1| mg/dL| 0.0 - 0.2| |
|Albumin| 4.69| g/dL| 3.5 - 5.2| |
|Sodium (Na)| 141| mEq/L| 136 - 145| |
|Potassium| 4.56| mEq/L| 3.5 - 5.1| |
|Calcium (Ca)| 9.6| mg/dL| 8.4 - 10.5| |
|Magnesium| 2.03| mg/dL| 1.5 - 2.3| |
|Iron (serum)| 111| ug/dL| 59 - 158| |
|Iron binding capacity| 167| ug/dL| 155 - 355| |
|CRP| 0.08| mg/dL| 0 - 0.5| |
|Free T3| 3.25| pg/mL| 2.28 - 4.00| |
|Free T4| 1.03| ng/dL| 0.60 - 1.25| |
|TSH| 3.35| mU/mL| 0.38 - 5.33| |
|Vitamin B12| 297| pg/mL| 126.6 - 505| |
|Folate| 12.83| ng/mL| 3.1 - 19.9| |
|Ferritin| 63.5| ng/mL| 23.9 - 336.2| |
(PSA)| 0.74| ng/mL| 0 - 4| |
|25-Hidroksi Vit. D| ▼20.37| ng/mL| 30 - 100| (started taking Vit D3 5000iu with K2 after this)
(Hb A1C) 5.4

Hemogram was all good.

Took another blood test 4 days later (18th of March) , different labs this time (THIS IS STILL BEFORE THE NEBIDO INJECTION) :
Free T4 1,20 ng/dL 0.93 - 1.7
TSH 2,73 μIU/ml 0.27 - 4.2
SHBG 22.1 nmol/L 18.3-54.1 nmol/L
Testosterone, total 279,6 ng/dL 249 - 836

On 27th of March , due to my low TT , my urologist injected me Nebido himself without even checking my LH and FSH , E2 or SHBG. Thyroid levels was not even an issue to him. By that time i’ve had no idea what’s going on and just purely trusted my doctor. Huge mistake.

Nebido is the only option here if you want to buy with prescription. Though I have now access to Cypionate or Enanthate if i wish to use them.

3 days after my injection , insomnia began (was waking up at 3am and could not go back to sleep) and it was followed by frequent heart palpitations (extrasystole). Cardiologist requested a holter monitor and palpitations occured 49 times a day , but he said “You are not gonna die from this , you’re ok , no worries.”

Below is my blood test 1,5 weeks after my Nebido injection :

Total Cholesterol 207 mg/dL < 200 mg/dL
LDL Cholesterol 151 mg/dL <100 mg/dL
HDL Cholesterol 41 mg/dL > 35 mg/dL
Total/HDL Cholesterol 5.0 < 5.9
Triglyceride 74 mg/dL < 200 mg/dL
LDL Subgroups
Total Cholesterol *207 mg/dL < 200 mg/dL
VLDL Cholesterol *32 mg/dL < 22 mg/dL
MID-IDL Subgroups
MID-C 6 mg/dL < 23 mg/dL
MID-B 6 mg/dL < 15 mg/dL
MID-A 11 mg/dL < 25 mg/dL
Large LDL Subgroups
LDL 1 49 mg/dL < 57 mg/dL
LDL 2 *47 mg/dL < 30 mg/dL
Small LDL Subgroups
LDL 3 *9 mg/dL < 6 mg/dL
LDL 4 0 mg/dL
LDL 5 0 mg/dL
LDL 6 0 mg/dL
LDL 7 0 mg/dL
HDL Total 46 mg/dL > 40 mg/dL

DHEA-S 188 ug/dL 88.9-427 ug/dL
17-Hidroksipregnenolon 117 ng/dL 30-350 ng/dL
Albumin 4.3 g/dL 3.5-5.2 g/dL
Estradiol (E2) 58.7 pg/mL 25.8-60.7 pg/mL
17-Alfa-OH-Progesterone 0.16 ng/mL 0.08 - 1.9 ng/mL
Progesterone < 0.05 ng/mL 0.05-0.149 ng/mL
Prolactin (PRL) *16.9 ng/mL 4.0-15.2 ng/mL

*Total Testosterone 9.85 ng/mL 2.49-8.36 ng/mL

T4 (Tiroksin) 5.56 ug/dL 5.13-14.1 ug/dL
FREE T4 1.16 ng/dL 0.93-1.71 ng/dL
T3 (Triiyodotironin) 89 ng/dL 83-200 ng/dL
FREE T3 3.15 pg/mL 2.04-4.40 pg/mL
TSH 3.56 uIU/mL 0.27-4.20 uIU/mL
Reverse T3 132.2 pg/mL 90-215 pg/mL
Tiroid Peroksidaz Antibody < 9 IU/mL < 34 IU/mL
Tiroglobulin (hTG) 7.78 ng/mL 3.5-77 ng/mL
Anti-Tiroglobulin Antibody <10 IU/mL < 115 IU/mL
Iron 79 ug/dL 59-158 ug/dL
Ferritin 50.9 ng/mL 30-400 ng/mL
Total Iron Binding Capacity 269 ug/dL 250-450 ug/dL
SHBG 21.2 nmol/L 18.3-54.1 nmol/L
Cortisol 17 ug/dL AM 06:00 - 10:00 : 6.02-18.4 ug/dL
PM 16:00 - 20:00 : 2.68-10.5 ug/dL
Androstenedion 2.27 ng/mL 0.60-3.10 ng/mL
Calcitonin 1.4 pg/mL < 14.3 pg/mL
Anti-TSH Receptor Antibody (TRAK) < 0.3 IU/L <1.75 IU/L
Hemoglobin A1c % 5.0 % 4.0-5.6

  • 31 mmol/mol 22-38 mmol/mol
    Estimated Avg. Glucose 97 mg/dL
    Hemogram all in range other than :
    Monocyde *% 8.4 - ref. r % 2-8
    Eosinophil *% 0.7 - ref. r % 2-4
    MPV *11.7 um3 7.8-11.0 um3

Fast forward to beginning of May , my heart palpitations stopped , insomnia is no longer an issue. I thought i am getting ok but after 25th of May i am even worse than before.
I can’t even walk straight sometimes , low blood pressure constantly around 95-55 , dizziness and lightheadedness even if try to slowly stand up . I sometimes struggle to keep eyes open during day , sleepy , tired , you name it. Also one strange thing is when i lie sideways , after a while i feel pressure on my chest… It’s like mild chest pain.

So i took another blood test thinking this might be the reason of both exogenous testosterone’s effect is gone and my own production of testosterone is still shut down meaning low T and low e2.

Below are from 30th of May:

*Estradiol (E2) 17.5 pg/mL 25.8-60.7 pg/mL
Total Testosterone 2.93 ng/mL 2.49-8.36 ng/mL
FSH *0.4 mIU/mL 1.5-12.4 mIU/mL
LH *< 0.3 mIU/mL 1.7-8.6 mIU/mL
Prolactin (PRL) 13.7 ng/mL 4.0-15.2 ng/mL
T4 (Tiroksin) 5.52 ug/dL 5.13-14.1 ug/dL
FREE T4 1.17 ng/dL 0.93-1.71 ng/dL
*T3 (Triiyodotironin) 78 ng/dL 83-200 ng/dL
FREE T3 2.59 pg/mL 2.04-4.40 pg/mL
TSH 2.95 uIU/mL 0.27-4.20 uIU/mL
Tiroid Peroksidaz Antibody 11 IU/mL < 34 IU/mL
Anti-Tiroglobulin Antibody <10 IU/mL < 115 IU/mL
Total PSA 1.00 ng/mL < 1.4 ng/mL
Again Hemogram was all good other than :
Monocyde *% 8.1 - ref. r % 2-8
Eosinophil *% 1.1 - ref. r % 2-4
MPV *11.9 um3 7.8-11.0 um3

I will get another blood test at the end of June , which will be 3 months after my Nebido injection.
I will post it here also and i will have to decide depending on the experienced people’s advise here because there is no TRT specialist where i live… I saw 1 urologist and 3 endos. and one anti-aging specialist. I gave up and understood that i have to self medicate if i can.

So for now , I have the following questions and i need your help :

1)Why am i constantly dizzy and have low BP? It’s been like this for 25 days now.

2)When does my LH and FSH goes back to normal? Or will they? Because i really want to see my normal LH and FSH levels before i jump to TRT again.

3) I started to take 25mg of Iodoral along with 5 brazil nuts everyday and will be ending the IR next week. If my thyroid levels aren’t optimal after the IR , what kind of thyroid medication will i need? And will those meds shut down my natural production of thyroids? Will i have to take them forever?

4)What kind of TRT protocol would you advise me with my SHBG levels of low 20’s? We are yet to see my normal E2 values unfortunately.

5)Fertility…
We will try for another child in 5 years time. If i start TRT now , what will i have to do after 5 years? I have read here that HCG during TRT can cause problems.

Thank you in advance!

2

I doubt that you have anything wrong with your thyroid. Those numbers aren’t the end of the world. As for LH and FSH, they SHOULD be near zero when you have exogynous test in your system. Your pituitary should naturally stop making those things when your test level is high enough, it’s part of a feedback loop, so they won’t come up until sometime after the test has left you. They come up when you resume natural production, if you resume it. So, while mostly everyone hates Nebido, what you went through was your body trying to adjust to having testosterone again. You are back down to a crappy low level (Not that it went very high with the Nebido). So, at this point, you should have already had another Nebido shot if that’s what you want to go with, and you ride out the adjustment. The E2 numbers are no big deal, they didn’t even really go up much.
Your cholesterol numbers don’t mean anything without knowing what they were before the shot, and it would be really strange if one shot had any impact at all on them.
If you want a child, you will have to either start taking HCG shots around that time, or go off TRT altogether and do some form of restart clomiphene citrate or tamoxifen.

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3

This is sub optimal thyroid numbers, the total amount of thyroid hormones is bottomed out and is why TSH is elevated. I believe you have subclinical hypothyroidism and TRT will not work well if you have a thyroid that isn’t performing well. TSH when on the higher end (>2.5) is a better indication there are problems do to very low T4 which is the storage of thyroid hormones.

T4 should be midrange, this would give your body more to work with and I would expect Free T3 to increase and you feel better. You may have to pay out of pocket for treatment as I believe it will be difficult to get treatment from insurance or a state healthcare provider.

I have seen men with better thyroid numbers than you who started thyroid treatment and relieved all their symptoms, there is medical literature which shows people showing benefit on thyroid medicine who had normal thyroid labs.

Almost everyone goes through a rough patch at first when starting TRT as your natural production is shutdown. SHBG is low and therefore you should have decreased the nebido dosage. If you can get your hands on cypionate, I recommended injecting 25mg EOD.

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4

There’s a bunch in your bloodwork. Here is my .02

  • You’re probably hypothyroid. I get the “free hormone hypothesis” as it’s called, but imo, it’s wrong. Free T4 and free t3 are something like .04 and .4% of totals, turnover varies by adequateness of substrate supply, and much t3 is converted locally. Regardless, it’s harmless, and I suggest you try some t4 (synthroid) at 100 mcg/day to start. If you feel nothing after a few months, then discontinue. I have had half a dozen friends feel better trying thyroid hormone despite adequate free hormones (they all had lowish totals). Median and mean total t3 is 125, with a standard deviation of 25, so you’re at a low percentile for total t3 too. Tsh fluctuates throughout the day and is a pituitary hormone. Even if the signal’s adequate, you don’t know how much the thyroid can produce from the signal. I’d suggest you get total t4 >8 and total t3 >100. If you do that free t3 will also be > 3.

  • That’s entirely too much selenium. The enzyme responsible for deiodinase activity (t4 ->t3 conversion) is saturated at 50 mcg/day. There’s variable amounts in a brazil nut: from 50 to 200 mcg/day, so that’d be 250 to 1 mg/day. Note that in a few studies (you can find on pubmed), supplementing >200 mcg/day actually suppressed thyroid conversion in humans. I suggest you discontinue and in a few months, you can add in 50 mcg/day. Note the half life is long - 1/2 - 3/4ths a year, so it’s slow to leave.

  • Nedido (Testosterone Undecanoate) has a 20-30 day half-life in different oils. Test, regardless of preparation, should be dosed at 1/2 to 1x (max) its half life. That’d be every 2 weeks to every month. The every 12 wks protocol is akin to the first generation cyp/enanthate protocols of 250 mg every 3 weeks. Those were terrible but it wasn’t cyp/enan’s fault. I’m afraid you might never feel good with such an infrequent dosing schedule. I have been taking 250 mg undecanoate every 2 weeks for a little while and feel great.

Additionally:

  • your b12 is low. You may need >600 for a few nervous system functions. Buy a supplement.
  • your ferritin (storage iron) is lowish - you need a bit more for cellular function. You can by a supplement to bring blood levels to 100-150.
  • I suggest you stop the iodine, use iodized salt and eat fish (also for the selenium).
  • Eat some liver or otherwise get some preformed vitamin A if you supplement vitamin D for long.
  • get you a combination pregnenolone/dhea at 25 mg each if you continue with trt and it’s safe even if you don’t. Just take 1 a day. I have a product from wonderlabs I like.
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5

^^ Good advce here.

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MR. INQUISITIVE IS RIGHT ON TRACK…
All that he said is correct. Additionally, your HPA axis is disregulated. Note that all of your adrenal hormones are in the lower 1/3 of the range. This is typical of disregulation, as are your symptoms.
Its a long road, but you can recover.

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Thank you all for the feedback! I really appreciate it.

That is what i am after. I only took one injection of Nebido on 27th of March and next week it will be 3 months. How long does it take for the exogenous testosterone to leave my system?
My last blood work was at 30th of May (which is in my original post) and my E2 and TT was both very low and LH and FSH wasn’t recovered yet. Right now i feel dizzy and extremely sleepy/tired 24/7. I can’t go and workout because i’ve got no energy and it makes me even more dizzy when i lift. Is this normal when you have low E2 ?

8

Thank you @systemlord

If i start thyroid treatment , will my own production of thyroid shutdown so i have to be treated forever? Just like exo. T and natural T. production? Or is this treatment temporary? Please excuse me as i have zero knowledge with thyroid medications.

9

Thank you @mr.inquisitive for the thorough feedback!

I actually only took one Nebido injection… which was almost 3 months ago… Since i had side effects like frequent heart palpitations and insomnia , i decided not to continue with the second shot , which was planned to be 6 weeks after the 1st. My protocol after that was supposed to be every 6 weeks of entire 1000mg/4ml Nebido injections.

Do you think with my story and blood works , every 2 weeks 250mg undecanoate will be good for me? Also what do you do with the remaining 3ml (750mg) of the ampule?
It would be so expensive to use Nebido every 2 weeks if i am to throw away the remaining 3ml of the ampule.

Oh well… I will stop eating the brazil nuts. How about my IR? Should i continue? I did it purely based on @KSman 's sticky.

10

Thank you for bringing this up.

I have no idea what that is. I will google it.
How does one treat it though?

Can you give some examples from my blood work if that’s not too much to ask for?

Thank you.

11

You would just load 4 needles and then use them as needed on shot days, you would’t throw anything away. It can sit in a syringe in the drawer and wait, it won’t go bad.
I think that you have low everything and need to be on some kind of test, or get some Clomid and do a restart and see if that works.

12

Well, from your labs, you could use more T. If you are truly hypothyroid, then T could be lower because of it, and vitamin D at 20 could have an impact as well. But even correcting both of those, that might bring it up 100-200 max. You’re 36 (so am I btw), and T production is only going to get worse. It is important.

I’d really try to stay more frequent than monthly. You could break the amp, inject some and load the rest in a few syringes.

13

Exactly as hardartery said about splitting the amp.

As for your other questions, there are multiple fertility threads here. Read them and have a plan at least 6 months before you start trying. Make sure doc is open to prescribing what you need - hcg, clomid, and maybe nolva.

The thyroid feedback loop isn’t as rough as the Testosterone one. Exogenous thyroid will lower tsh but it won’t go away. If you stop taking it, it may take a bit for the gland to produce more from more stimulation again but you’ll quickly be right back where you started, which in your case, it looks like that might not be enough. Trust me, a pill a day is a small inconvenience for having 25% more metabolism. If you need it, I absolutely wouldn’t hesitate.

I’ve taken high dose iodine before and I’m still on the fence about it. I still haven’t found a study I like that completely addresses all the counter arguments. If you were taking the iodine before those thyroid labs then you might want to stop and wait a month to see if the totals go up before you start years of replacement therapy. If you’re deficient it very well could mess up your function but if not it probably won’t be a miracle. Thyroid function is thought to be about 50% genetic and glands also lose cells and go out with age, for reasons besides nutrient inadequacies. This paragraph is as much opinion as fact, so ultimately, you’ll have to do your own research.

best of luck to you.

14

So the pill you are advising me is Snythroid (or equivalent since we dont have Snythroid here)?

If i understand you right this will increase my total t4 meaning more t3 and ft3?
So no need for t3 specific treatment?

Thank god i can get them without prescription here. Otherwise idiot doctors here would never prescribe me those easily.

Thank you once again @mr.inquisitive . Your help is much appreciated!

15

If you need thyroid treatment do to a poorly functioning thyroid, you need the treatment end of story. There is no such thing as temporary hormone replacement unless you wish to return to the state you were in before treatment.

T3 is low because T4 is low, thyroid treatment will increase T4 and therefore T3.

16

Any t4 will work. It’s also called levothyroxine. Synthroid is just a common brand.

Personally, I prefer t4, especially as a first attempt. If that doesn’t work there can be other options to try. imo, t3 should be a last resort. In the body, most t3 comes from conversion from t4.

17

Thank you @mr.inquisitive

I will def. look into it.

Also I will start TRT again with 50mg Enanthate twice a week protocol and see how i feel.

I just hope heart palpitations and insomnia doesn’t come back…

For fertility , i looked for answers in this forum but it’s not same for everybody i suppose. My plan is to try my luck with fertility meds after couple of years of TRT. (if i can stay on TRT that long without issues)

18

Do you have an update for us?
LH / FSH bloodwork or something?

Can you describe after how many weeks your LH/FSH went back to baseline?

19

I pinned Nebido in end of March. It was first and last injection of Nebido. Then my LH and FSH went back to normal in late June/beginning of July. Although they were really low. Then i decided to go on with my next protocol. Which is in another thread below :

20

@pita13 man i cant tell you how happy i am that someone brough this up.
I was already stressing i somehow got poisoned by something in my gear even though it is from a pharmacy).

I was on exogenous testosterone for 5 months and exactly same symptoms happened to me. Upon stopping and starting clomid i first stsrted feeling this extreme fatigue, like wanna collapse, that bad.
Then, few days later, came rhis feeling of nausea and low blood pressure, basically every time i would bend and stand up i would feel malaise, extreme shortness of breath and get heart palpitations.

Did 3 weeks of clomid, symptoms didnt improve, felt ever more fatigued. And hardcore anxiety and panic attacks with constant heart palpitarions.

decided to pin 200mg test e immediately felt good, energy, libido skyrocketed and shortness of breath improved.
So now i am at a point of starting hcg for 10 days and then bang another week of clomid and then i am done with these damn drugs for some time.

Doctors are at a loss about what is happening to me.
My oxygen satiration is 99% yet i feel short of breath and have all these pains all over my body.

My intuition tells me that i am going through withdrawals.
They sent me to the psychiatrist last time i was at the ER with all these complaints as all labs came up perfect.

So i am really starting to believe it is the withdrawals.

Btw, @pita13, you from Croatia? I see that your reference ranges are the same as mine when i go to get bloodwork done.

Edit: You got palpitations on nebido because the doctor who gave you the shot doesnt know what he is doing and he is planning to give you a drug with a half life of 21 days every 56 - 84 days (8-12 weeks for nebido).
That is a massive dose and no wonder your cns went into overdrive.

I also get palpitations initially when i inject a large dose, until levels somewhat stabilize.

even though you might feel great on a supraphysiologic dose of T (i certainly do) it is not good to stay there for a prolonged period of time, not just because of physiological side effects, but also due to the psychology.